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In This Issue of JAMA Internal Medicine
April 2019


JAMA Intern Med. 2019;179(4):461-463. doi:10.1001/jamainternmed.2018.5486


In this population-based study, Friedman and colleagues used data from California’s prescription drug monitoring program to examine the degree to which differential exposure to opioids via the health care system by race/ethnicity and income could be driving the observed social gradient of the current opioid epidemic. Results showed that the race/ethnicity and income pattern of opioid overdoses mirrored prescription rates, suggesting that differential exposure to opioids via the health care system may have induced the large, observed racial/ethnic gradient in the opioid epidemic. Adams and Giroir provide the Invited Commentary.

Invited Commentary and Related Articles 1 and 2

Schnabel and colleagues performed this observational prospective cohort study of 44 551 French adults 45 years or older to assess the association between ultraprocessed foods consumption and all-cause mortality risk. Participants were selected from the French NutriNet-Santé Study and completed at least 1 set of 3 web-based 24-hour dietary records during their first 2 years of follow-up. Ultraprocessed foods were characterized as ready-to-eat or -heat formulations made mostly from ingredients usually combined with additives. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality.

In this cohort study and descriptive analysis of low-value care, Badgery-Parker and colleagues examined the incidence of hospital-acquired complications (HACs) in patients undergoing 1 of 7 procedures for which hospital admission is usually not needed. The 7 procedures included endoscopy, knee arthroscopy, colonoscopy, spinal fusion, endovascular repair of abdominal aortic aneurysm, carotid endarterectomy, and renal artery angioplasty. The highest rates of HACs occurred with spinal fusion, endovascular repair of abdominal aortic aneurysm, carotid endarterectomy, and renal artery angioplasty procedures. For most procedures, the most common HAC was health care–associated infection. These findings suggest that use of these 7 procedures in patients who probably should not receive them could be harmful.

Continuing Medical Education

In this epidemiological study, Basu and colleagues evaluated the association of primary care physician supply and both all-cause and cause-specific mortality by comparing US population and insurance claims data with data on density of primary care physicians and specialist physicians. Results showed an increase in US physicians from 2005 to 2015, although the per capita supply decreased in that time owing to disproportionate losses of primary care physicians in some counties and population increases. Additional primary care physicians and specialist physicians per population was associated with an increase in life expectancy. Zabar and colleagues provide the Invited Commentary.

Invited Commentary

Leiba and colleagues performed this retrospective cohort study to investigate the association between established hypertension among otherwise healthy adolescents and future end-stage renal disease. The cohort included 2 658 238 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. The primary outcome was recorded end-stage renal disease, including hemodialysis, peritoneal dialysis, and renal transplant diagnosed at follow-up between January 1, 1990, and December 31, 2014. Results showed that hypertension was associated with a doubling of the risk of future end-stage renal disease in an otherwise healthy adolescent population.

Meyers and colleagues performed this cross-sectional study to characterize trends in switching to and from Medicare Advantage among high-need beneficiaries and to evaluate the drivers of disenrollment decisions. A total of 13 901 816 enrollees were included in the analysis, which showed substantially higher disenrollment from Medicare Advantage plans among high-need and Medicare/Medicaid–eligible enrollees compared with non–high-need enrollees and Medicare-only enrollees. Findings also suggested that star ratings have the strongest association with disenrollment trends, whereas increases in monthly premiums are associated with a greater likelihood of switching plans.

In this registry-based cohort study, Schaefer and colleagues compared adverse event rates up to 3 years after initiation of treatment among patients receiving combination warfarin and aspirin therapy (without a therapeutic indication for aspirin use) vs those receiving warfarin monotherapy. Results showed that at 1 year, patients receiving combination warfarin and aspirin compared with those receiving warfarin only had higher rates of overall bleeding, major bleeding, emergency department visits for bleeding, and hospitalizations for bleeding. Rates of thrombosis were similar at 1 year. Similar overall findings persisted during 3 years of follow-up as well as in sensitivity analyses.

In this cohort study of 3123 individuals with stages 2 to 4 chronic kidney disease (CKD), Waikar and colleagues assessed whether urinary oxalate excretion was a risk factor for more rapid progression of CKD toward kidney failure. Oxalate is a potentially toxic terminal metabolite that is eliminated primarily by the kidneys but has not been investigated as a potential contributor to more common forms of CKD. Findings from the data analysis showed that higher 24-hour urinary oxalate excretion may be a risk factor for CKD progression as well as end-stage renal disease in individuals with CKD stages 2 to 4. Ix provides the Invited Commentary.

Invited Commentary